Carotid Arteries: How to Protect Them to Avoid Stenosis

The carotid arteries are essential to our body: they are two arteries that run through the neck, one on the right and one on the left, and carry blood to the brain. During this activity, the carotid arteries can become diseased, and the lumen of the carotid artery narrows due to the accumulation of atherosclerotic plaque. Atherosclerotic plaque typically forms at the carotid bifurcation, where the carotid artery divides into the internal one, which goes to the brain, and the external one, which goes to the facial muscles. Since stenosis is a condition caused by alterations in the artery wall, caused by increased cholesterol, the following are essential to protecting the carotid arteries:

Have low cholesterol and control it as directed by your doctor
Not smoking: Nicotine can irritate the lining of the arteries
Check it pressure and make sure it is not too high
Do physical activity on a regular basis
Maintain normal body weight
Check, with the help of your doctor, for possible hereditary factors

Index of topics

Carotid stenosis

Carotid stenosis generally presents no particular symptoms, which makes it even more insidious. When the narrowing of the carotid artery becomes severe enough to deprive the brain of blood, cerebral ischemia can occur in the form of a transient ischemic attack (TIA) or ischemic stroke. TIA: The reduction in blood flow to the brain is reversible and short-lived (less than 24 hours, typically 30 to 60 minutes). It can be a precursor to a full-blown stroke later. In ischemic stroke , the compromised blood flow to the brain due to the presence of an embolus lasts longer, resulting in irreversible damage. Ischemic strokes resulting from carotid stenosis account for 20-25 percent of all strokes. Finally, with a stroke, blood flow to the brain is completely blocked: this is the leading cause of disability in Italy and the third leading cause of death in Western countries.

Symptoms

Carotid stenosis can also present with some very obvious symptoms.

Loss of sensation on one side of the body or face.
Paralysis of one side of the body or face (arm or leg paralysis, facial paralysis).
Lack of strength in the arm and leg
Poor coordination in movements
Visual disturbances (loss of vision, double or blurred vision).
Loss of consciousness
Difficulty speaking (aphasia) or articulating words (dysarthria).

However, you may also experience dizziness , loss of balance, or a sudden, severe headache for no apparent reason. If these symptoms occur, it's important to see a doctor and have diagnostic tests performed to determine the cause. Sometimes, a TIA can also occur due to blockages in other arteries. Therefore, it's vital to promptly identify the cause of the problem.

Diagnosis

The most important test for preventing carotid stenosis is carotid color Doppler ultrasound , which is indicated for those who have already shown cerebral symptoms, but is also useful in asymptomatic individuals, especially those with cardiovascular risk factors (high cholesterol, diabetes, obesity, a sedentary lifestyle, hypertension, smoking, and advanced age). Depending on the extent of the narrowing, other tests, such as a CT scan or MRI of the carotid artery, may be prescribed.

Cure

When you begin to feel symptoms or experience cases of TIA or stroke, you need to move on to treatments, which vary depending on the extent of the damage.

carotid obstruction symptoms — *^{Image by DCStudio on Freepik}*

Conservative therapy

Conservative therapy is indicated for mild carotid stenosis . The doctor will then advise the patient on how to improve their overall lifestyle and may recommend a new, healthier and more balanced diet, recommending regular physical activity. People with obesity or overweight are encouraged to lose weight, as significant risk factors, such as smoking and alcohol , should be avoided at all costs. In cases of hypercholesterolemia , atherosclerosis , and cardiovascular disease , appropriate treatments, including the prescription of specific medications, are also necessary.

When should carotid artery surgery be performed?

Surgery is indicated only in cases of severe stenosis. This means a reduction in the lumen of the carotid artery of no less than 70-80 percent. Obviously, other factors also play a role, such as the patient's general condition and the heredity of the disease. Similarly, surgery is necessary after a stroke or TIA. Surgery, as mentioned, is essential following an ischemic or cerebral stroke, but also after a minor event such as a TIA. In certain cases, surgery may also be required for high-risk conditions to prevent fatality.

Surgical or endovascular therapy may be indicated for patients with severe stenosis and, therefore, significant carotid occlusion. This is also true for patients experiencing symptoms, and intervention is required if the occlusion is greater than 50%. For those without symptoms, surgery is generally only performed if the carotid narrowing reaches 70-80%. Before confirming surgery, the physician also evaluates the structure of atheromas , i.e., plaques that act as obstructions in the carotid arteries. Soft plaques , for example, are associated with a higher risk of clots or emboli. Therefore, specialists are more likely to recommend surgery in this case. If the occlusion is borderline, even hard plaques must be removed with appropriate surgical techniques , depending on the case.

Carotid endarterectomy

This type of surgery involves making an incision in the carotid artery, precisely at the level of the plaque, and removing the atheroma or various plaques obstructing blood flow. If complete removal is not possible, or the condition is severe, the surgeon may also proceed with carotid enlargement by inserting a patch that keeps the carotid conduit open.

Percutaneous angioplasty with stent

The second surgical technique involves dilating the at-risk carotid arteries by inserting a stent with the help of a catheter. The cardiologist surgeon inflates a sterilized balloon and inserts it into the affected carotid arteries to crush the atheromas. He then inserts a self-expanding stent, which will keep the carotid artery dilated. During the operation, atherosclerotic plaques can rupture and lose fragments. To prevent debris from creating problems for the cardiovascular system, a cerebral protection system is inserted. The cerebral protection system , such as the Sentinel transcatheter , is a device composed of two filters specifically designed to trap and remove debris during surgical procedures.

Carotid arteries: how to protect them to avoid stenosis